Labor and Birth

Question 1

How is the first stage of pregnancy characterized and what are the three phases?

Answer 1

• Onset of labor until full dilation and effacement (10 cm/100%)
• Three phases: latent, active, transition

Question 2

How is the second stage of pregnancy characterized?

Answer 2

• Full dilation and effacement until birth of fetus
• Stretch receptors in pelvic floor activated as fetus passes through pelvis

Question 3

When is the third stage of pregnancy?

Answer 3

From birth of fetus until delivery of placenta

Question 4

When is the fourth stage of pregnancy?

Answer 4

From delivery of placenta until 2 hours postpartum

Question 5

What does true labor look like?

Answer 5

• bloody show
• contractions felt in back and abdomen
• contractions get longer/stronger/closer together
• progressive cervical change
• ROM (rupture of membranes)

Question 6

What does false labor look like?

Answer 6

• contractions mostly felt in lower abdomen
• contractions have little to no pattern and do not get stronger
• contractions stop with hydration or activity
• no cervical change

Question 7

What are the three questions to ask during initial assessment (triage)?

Answer 7

1. How is baby moving?
2. Are you having any vaginal bleeding?
3. Are you leaking any fluid?

Question 8

What kind of data is collected during initial assessment of laboring patient?

Answer 8

• Three questions!
• What is their indication for labor (contractions, rupture of membranes (ROM), etc.)
• Fetal heart rate and contraction assessment (frequency, duration, intensity, rest)
• Cervical exam (dilation, effacement, station, and presenting part)
• Vital signs
• Thorough past medical and surgical history
• Any issues with current pregnancy (hypertension, diabetes, etc.)
• Current medication use
• Allergies
• Assessment (heart, lungs, edema, DTRs, etc.)

Question 9

What are the 4 P’s that impact labor progression?

Answer 9

• Passenger (fetus)
• Passageway (birth canal)
• Powers (contractions)
• Psychologic response

Question 10

What are the four categories of Passenger?

Answer 10

Presentation:

• Cephalic
• Breech
• Shoulder

Fetal head:

• Size
• Molding

Fetal lie:

• Long axis of fetus (spine) in relation to long axis of birthing parent (spine)

Fetal attitude:

• How flexed is the fetal head to its body? A flexed head navigates pelvis more efficiently

Question 11

What is the ideal positioning of the fetal head during a vaginal birth?

Answer 11

• Baby is chin to chest
• Cephalic presentation is ideal (head down, chin tucked to chest, facing mom’s back)
  
  • Vertex presentation is the preferred subtype

Question 12

What does Passageway consist of?

Answer 12

• Bony pelvis
• Cervix
• Pelvic musculature
• Vagina

Question 13

What is occurring during Power?

Answer 13

• 1st stage of labor
  
  • dilate and thin (efface) the cervix
• 2nd stage of labor
  
  • expel fetus (urge to bear down)

Question 14

Describe Psychological response.

Answer 14

• Overall emotional response to pregnancy
• Previous pregnancies/births/children
• Support system
• Prenatal education and coping abilities
• Cultural factors
• Emotions may fluctuate throughout labor

Question 15

What are the types of external fetal monitoring?

Answer 15

• Ultrasound monitors fetal heart rate
• Tocometer (toco) measures frequency and duration of contractions

Question 16

How does internal fetal monitoring work?

Answer 16

• Fetal scalp electrode monitors heart rate
• Intrauterine pressure catheter (IUPC) measures frequency, duration, and intensity (mmHg)

Question 17

When is internal monitoring indicated?

Answer 17

• difficulty obtaining tracing with external monitoring
• confirmation of low heart rate

Question 18

What is the fetal heart rate baseline?

Answer 18

110-160 beats per minute

Question 19

What is variability in fetal monitoring?

Answer 19

Beat to beat fluctuations, indicates
neurologically-intact fetus

Question 20

What are the different kinds of variability?

Answer 20

• absent: looks like a flat line
• minimal: barely any changes (<5 beats)
• moderate: great! (6-25 beats)
• marked: tells you nothing about the fetus (>25 beats)

Question 21

What are decelerations in fetal monitoring and the different types?

Answer 21

• Decreases from baseline classified by length and relation to contraction
• early, late, variable

Question 22

What are early decelerations and what are they caused by?

Answer 22

• mirror contractions, benign
• often caused by fetal head compression
• no intervention needed

Question 23

What are variable decelerations and what are they caused by?

Answer 23

• sharp, abrupt decrease in heart rate
• often caused by umbilical cord compression
• does not need to be related to contraction
• interventions: position change and amnioinfusion

Question 24

What are late decelerations and what are they caused by?

Answer 24

• start after the contraction has peaked, gradual decrease
• can be caused by poor placental perfusion, hypoxia, maternal hypotension, tachysystole (more than 5 contractions in 10 minutes), infection, etc.
• Interventions: Change position, fluid bolus, oxygen, d/c pitocin, notify provider

Question 25

How are contractions characterized during fetal monitoring?

Answer 25

• Baseline: Resting state of pressure in the uterus between contractions
• Peak: Maximum strength of contraction
• Frequency (2-3 min)
• Length (60-90 sec)
• Strength (IUPC or palpation)
• Resting tone

Question 26

What to do during SROM (spontaneous rupture of membranes)?

Answer 26

• Note time, color, amount, odor
• Can use bedside diagnostic tests to confirm SROM

Question 27

What to know about AROM (artificial rupture of membranes)?

Answer 27

• Note time, color, amount, odor
• Fetal head should be well engaged in pelvis to prevent cord prolapse
• Procedure is known as amniotomy
• Can be used to augment labor